Toric设计角膜塑形镜矫正青少年近视合并中高度散光的近期疗效

The short-term result of Toric orthokeratology for correction of myopic teenagers with moderate to high astigmatism

目的探讨Toric设计角膜塑形镜矫正青少年近视合并中高度散光的近期疗效。方法选取2016年1月—10月天津市眼科医院收治的30例青少年近视合并散光患者,共58只眼,平均年龄10.62(8～14)岁,近视屈光度-0.75～-5.00 D,散光-1.50～-3.00 D。检查并验配Toric设计角膜塑形镜,分别于戴镜后1 d、1周、1个月和3个月复诊,检查裸眼视力、最佳矫正视力、屈光度、角膜曲率、角膜地形图、眼前节检查以及镜片配适状态评估。结果第一副镜片验配成功率为96.55%。戴镜后1天、1周、1个月和3个月的近视度、散光度和裸眼视力均较戴镜前有明显改善(P<0.05)。戴镜3个月后,近视度平均降低(3.74±0.88)D,下降98.7%;散光度平均降低(1.68±0.55)D,下降80.8%;裸眼视力达到戴镜前最佳矫正视力水平。戴镜后各个时间点的角膜平坦K值(FK)、角膜陡峭K值(SK)和角膜散光值(CYL)较戴镜前明显降低(P<0.05),角膜表面规则指数(SRI)和角膜表面非对称指数(SAI)差异无统计学意义。所有患者在戴镜期间均未发生角膜色素环、角膜微囊水肿、角膜上皮剥脱及角膜感染等不良反应。结论Toric设计角膜塑形镜对青少年近视合并中高度角膜散光眼的矫正安全有效。

Objective To investigate the short term result of Toric orthokeratology （ortho-k） in correcting myopic teenagers with moderate to high astigmatism. Methods A total of 30 patients （58 eyes） who were treated in our hospital were included in this study. All patients met the inclusion criteria, and their average age were 10.62 yrs （8-14 years old）, with myopia of （-0.75）-（-5.00） D and astigmatism of （-1.50）-（-3.00） D. All of the patients were fitted with Toric ortho-k. The patients were followed up for 1 day, 1 week, 1 month and 3 months since eommeneenlent of lens wear, and then they were examined for uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, refractive error, corneal curvature and corneal topography. Results The success rate of first lens fitting was 96.55%. The myopia, astigmatism and uncorrected visual acuity were changed significantly （P 〈 0.05）in lday, 1 week, 1 month and 3 months compared with the baseline. After 3-month lens wearing, the myopia decreased by an average of （3.74±0.88） D, reduced 98.7%; and the astigmatism decreased by an average of （1.68±0.55） D, achieved 80.8% reduction. The uncorrected visual acuity was up to the best corrected visual acuity before wearing the lens, the difference showed no statistically significant. Moreover, there were significant differences in flat K, steep K and cylinder of corneal topography at each time point （P 〈 0.05）. Besides, the surface regular index and surface asymmetry index of corneal topography failed to show the significant difference. Finally, no significant corneal pigment ring, corneal mieroeapsule edema, corneal epithelial exfoliation and corneal infection, or other adverse events were observed during lens wearing. Conclusion Torie orthokeratology is a safe and effective correction treatment for myopic teenagers with moderate to high astigmatism.